Skip to main content

Advertisement

SpringerLink
Log in

P wave dispersion in patients with rheumatoid arthritis: its relation with clinical and echocardiographic parameters

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

P wave dispersion (PWD) is a sign for the prediction of atrial fibrillation (AF). The aim of this study was to assess P wave dispersion and its relation with clinical and echocardiographic parameters in patients with rheumatoid arthritis (RA). Thirty RA patients (mean age 49 ± 10 years) and 27 healthy controls (mean age 47 ± 8 years) were included in the study. We performed electrocardiography and Doppler echocardiography on patients and controls. Maximum and minimum P wave duration were obtained from electrocardiographic measurements. PWD defined as the difference between maximum and minimum P wave duration was also calculated. Maximum P wave duration and PWD was higher in RA patients than controls (P = 0.031 and P = 0.001, respectively). However, there was no significant difference in minimum P wave duration between the two groups (P = 0.152). There was significant correlation between PWD and disease duration (r = 0.375, P = 0.009) and isovolumetric relaxation time (r = 0.390, P = 0.006). P wave duration and PWD was found to be higher in RA patients than healthy control subjects. PWD is closely associated with disease duration and left ventricular (LV) diastolic dysfunction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wallberg-Jonsson S, Öhman ML, Dahlqvist SR (1997) Cardiovascular morbidity and mortality in patients with seropositive rheumatoid arthritis in northern Sweden. J Rheumatol 24:445–451

    CAS  PubMed  Google Scholar 

  2. Wislowska M, Sypula S, Kowalik I (1998) Echocardiographic findings, 24-hour electrocardiographic holter monitoring in patients with rheumatoid arthritis according to Steinbrocker’s criteria, functional index, value of Waaler–Rose titre and duration of disease. Clin Rheumatol 17:369–377

    Article  CAS  PubMed  Google Scholar 

  3. Koopman WJ, Moreland LW (2005) Arthritis and allied conditions. A textbook of rheumatology, 15th edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  4. Goldeli O, Dursun E, Komsuoglu B (1998) Dispersion of ventricular repolarisation: a new marker of ventricular arrhythmic in patients with rheumatoid arthritis. J Rheumatol 25:447–450

    CAS  PubMed  Google Scholar 

  5. Pırıldar T, Sekuri C, Utuk O, Tezcan UK (2003) QT dispersion in rheumatoid arthritis patients with and without Sjögren’s syndrome. Clin Rheumatol 22:225–228

    Article  PubMed  Google Scholar 

  6. Dilaveris PE, Gialafos EJ, Sideris S, Theopistou AM, Andrikopoulos GK, Kyriakidis M, et al. (1998) Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 135:733–738

    Article  CAS  PubMed  Google Scholar 

  7. Dilaveris PE, Gialofos EJ, Andrikopoulos GK, Richter DJ, Papanikolaou V, Poralis K, Gialafos JE (2000) Clinical and electrocardiographic predictors of recurrent atrial fibrillation. Pacing Clin Electrophysiol 23:352–358

    Article  CAS  PubMed  Google Scholar 

  8. Dilaveris PE, Gialafos JE (2001) P wave dispersion: a novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol 6:159–165

    Article  CAS  PubMed  Google Scholar 

  9. Arnett FC, Edwothy SM, Bloch DA, Meshane DJ, Fries JF, Cooper NS (1988) The American Rheumatism Association 1987 criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324

    Article  CAS  PubMed  Google Scholar 

  10. Steinbrocker O, Treger H, Cornelius H (1949) Therapeutic criteria in rheumatoid arthritis. JAMA 140:659–662

    CAS  Google Scholar 

  11. Van Gestel AM, Haagsma CJ, van Riel PL (1998) Validation of rheumatoid arthritis improvement criteria that include simplified joint counts. Arthritis Rheum 41:1845–1850

    Article  PubMed  Google Scholar 

  12. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458

    Article  CAS  PubMed  Google Scholar 

  13. Mutru O, Laakso M, İsomaki H, Koota K (1989) Cardiovascular mortality in patients with rheumatoid arthritis. Cardiology 76:71–77

    CAS  PubMed  Google Scholar 

  14. Mody GM, Stevens JE, Meyers OL (1987) The heart in rheumatoid arthritis: a clinical and echocardiographic study. Q J Med 65:921–928

    CAS  PubMed  Google Scholar 

  15. Cindas A, Gokce-Kutsal Y, Tokgozoklu L, Karanfil A (2002) QT dispersion and cardiac involvement in patients with rheumatoid arthritis. Scand J Rheumatol 31:22–26

    Article  CAS  PubMed  Google Scholar 

  16. Alkaabi JK, Ho M, Levison R, Pullar T, Belch JJF (2003) Rheumatoid arthritis and macrovascular disease. Rheumatology 42:292–297

    Article  CAS  PubMed  Google Scholar 

  17. Yildirir A, Aksoyek S, Calguneri M, Aytemir K, Kabakci G, Ovunç K, Nazlı F, Ozmen A, Oto A, Kes S (2000) QT dispersion as a predictor of arrhythmic events in patients with ankylosing spondylitis. Rheumatology 39:875–879

    Article  CAS  PubMed  Google Scholar 

  18. Cheema AN, Ahmed MW, Kadish AH, Goldberger JJ (1990) Effects of autonomic stimulation and blockade on signal-averaged P wave duration. J Am Coll Cardiol 26:497–502

    Article  Google Scholar 

  19. Leier CV, Meacham JA, Schall SF (1978) Prolonged atrial conduction: a major predisposing factor to atrial flutter. Circulation 57:213–216

    CAS  PubMed  Google Scholar 

  20. Aytemir K, Ozer N, Atalar E, Sade E, Aksoyek S, Ovunç K, Oto A, Ozmen F, Kes S (2000) P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation . Pacing Clin Electrophysiol 23:1109–1112

    Article  CAS  PubMed  Google Scholar 

  21. Yilmaz R, Demirbag R (2005) P-wave dispersion in patients with stable coronary artery disease and its relationship with severity of the disease. J Electrocardiol 38(3):279–284

    Article  PubMed  Google Scholar 

  22. Gunduz H, Binak E, Arinc H, Akdemir R, Ozhan H, Tamer A, Uyan C (2005) The relationship between P wave dispersion and diastolic dysfunction. Tex Heart Inst J 32:163–167

    PubMed  Google Scholar 

  23. Yilmaz R, Kasap H, Baykan M, Durmus I, Kaplan S, Celik S, Erdol C (2005) Assessment of left ventricular function by Doppler tissue imaging in patients with atrial fibrillation following acute myocardial infarction. Int J Cardiol 102:79–85

    Article  PubMed  Google Scholar 

  24. Bonfiglio T, Atwater EC (1969) Heart disease in patients with seropositive rheumatoid arthritis. Arch Intern Med 124:714–719

    Article  CAS  PubMed  Google Scholar 

  25. Reimer KA, Rodgers RF, Oyasu R (1976) Rheumatoid arthritis with rheumatoid heart disease and granulomatous aortitis. JAMA 235:2510–2512

    Article  CAS  PubMed  Google Scholar 

  26. Morris PB (1986) Rheumatoid arthritis and coronary arteritis. Am J Cardiol 57:689–690

    Article  CAS  PubMed  Google Scholar 

  27. Iglesias Cubero G, Rodriguez Reguero JJ, Rojo Ortega JM (1993) Restrictive cardiomyopathy caused by chloroquine. Br Heart J 69:451–452

    CAS  PubMed  Google Scholar 

  28. Ratliff NB, Estes ML, Myles JL, Shirey EK, McMahon JT (1987) Diagnosis of chloroquine cardiomyopathy by endomyocardial biopsy. N Engl J Med 316:191–193

    Article  CAS  PubMed  Google Scholar 

  29. Qasim FJ, Thiru S, Gillespie K (1997) Gold and D-penicillamine induce vasculitis and up-regulate m RBA for IL-4 in the Brown Norway rat: support for a role of Th2 cell activity. Clin Exp Immunol 108:438–445

    Article  CAS  PubMed  Google Scholar 

  30. Page J, Henry D (2000) Consumption of NSAIDs and the development of congestive heart failure in elderly patients. Arch Intern Med 160:777–784

    Article  CAS  PubMed  Google Scholar 

  31. Nashel D (1986) Is atherosclerosis a complication of long-term corticosteroid treatment? Am J Med 80:925–929

    Article  CAS  PubMed  Google Scholar 

  32. Landewe R, van den Borne B, Breedveld F, et al. (2000) Methotrexate effects in patients with rheumatoid arthritis with cardiovascular comorbidity. Lancet 355:1616–1617

    Article  CAS  PubMed  Google Scholar 

  33. Haagsma C, Blom H, van Riel PL, et al. (1999) Influence of sulfasalazine, methotrexate and combination of both on plasma homocysteine concentrations in patients with rheumatoid arthritis. Ann Rheum Dis 58:79–84

    Article  CAS  PubMed  Google Scholar 

  34. Schiff MH, Strand V, Oed C, Loew-Frriedrich I (2000) Leflunomide: efficacy and safety in clinical trials for the treatment of rheumatoid arthritis. Drugs Today Barc 36:383–394

    CAS  PubMed  Google Scholar 

  35. Tukek T, Akkaya V, Demirel S, Sozen AB, Kudat H, Atılgan D, Ozcan M, Guven O, Korkut F (2000) Effect of valsalva maneuver on surface electrocardiographic P wave dispersion in paroxysmal atrial fibrillation. Am J Cardiol 85:896–899

    Article  CAS  PubMed  Google Scholar 

  36. Evrengul H, Dursunoglu D, Cobankara N, Polat B, Seleci D, Kabukcu S, Kaftan A (2004) Heart rate variability in patients with rheumatoid arthritis. Rheumatol Int 24:198–202

    Article  PubMed  Google Scholar 

  37. Dekkers JC, Geenen R, Godaert GL, Bijlsma JW, van Doornen LJ (2004) Elevated sympathetic nervous system activity in patients with recently diagnosed rheumatoid arthritis with active disease. Clin Exp Rheumatol 22:63–70

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Mustafa Kemal University, Tip Fak. Arastirma Hastanesi, Bağriyanik mah, Ormanci cad, P.K. 3100, Antakya/Hatay, Turkey

    Hayal Guler

  2. Department of Cardiology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey

    Ergun Seyfeli, Ferit Akgul & Fatih Yalcin

  3. Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Mersin University, Mersin, Turkey

    Gunsah Sahin

  4. Department of Emergency Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey

    Mehmet Duru

  5. Department of Cardiology, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey

    Hayrettin Saglam

Authors
  1. Hayal Guler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ergun Seyfeli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gunsah Sahin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mehmet Duru
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ferit Akgul
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hayrettin Saglam
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fatih Yalcin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hayal Guler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Guler, H., Seyfeli, E., Sahin, G. et al. P wave dispersion in patients with rheumatoid arthritis: its relation with clinical and echocardiographic parameters. Rheumatol Int 27, 813–818 (2007). https://doi.org/10.1007/s00296-007-0307-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-007-0307-8

Keywords

Search

Navigation